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ICD-10 Guide
ICD-10 CodesE10.331

E10.331

Billable

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E10.331 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema.

Key Diagnostic Point:

E10.331 refers to a specific condition in which a patient has Type 1 diabetes mellitus accompanied by moderate nonproliferative diabetic retinopathy (NPDR) and macular edema. Type 1 diabetes is characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. Diabetic retinopathy is a common complication of diabetes, resulting from damage to the retinal blood vessels due to prolonged hyperglycemia. Moderate NPDR is identified by the presence of microaneurysms, retinal hemorrhages, and exudates, while macular edema indicates fluid accumulation in the macula, leading to vision impairment. The management of this condition often involves strict glycemic control, with target HbA1c levels typically below 7% to reduce the risk of progression of retinopathy. Insulin therapy is essential for Type 1 diabetes management, and patients may require adjustments based on their blood glucose monitoring and dietary intake. Regular ophthalmologic evaluations are crucial for early detection and management of retinopathy and macular edema.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes classifications and complications
  • Need for precise documentation of retinopathy severity
  • Differentiation between NPDR and proliferative diabetic retinopathy
  • Management of associated conditions like macular edema

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of evidence for insulin management plans
  • Inconsistent coding of diabetes complications

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of blood glucose levels, insulin regimen, and HbA1c results.

Common Clinical Scenarios

Management of Type 1 diabetes, insulin adjustments, and monitoring for complications.

Billing Considerations

Ensure comprehensive documentation of diabetes management and complications.

Ophthalmology

Documentation Requirements

Detailed findings from retinal examinations, including descriptions of retinopathy and macular edema.

Common Clinical Scenarios

Routine eye exams for diabetic patients, treatment of diabetic retinopathy.

Billing Considerations

Accurate staging of retinopathy is crucial for proper coding.

Coding Guidelines

Inclusion Criteria

Use E10.331 When
  • According to ICD
  • 10 coding guidelines, E10
  • 331 should be used when a patient has Type 1 diabetes with documented moderate NPDR and macular edema
  • It is essential to ensure that the documentation supports the diagnosis and that the severity of retinopathy is clearly stated

Exclusion Criteria

Do NOT use E10.331 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used during routine eye exams for diabetic patients.

Documentation Requirements

Document findings of retinopathy and any treatment plans.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinopathy severity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.331?

Coding E10.331 accurately reflects the patient's condition, allowing for appropriate management and treatment of diabetes and its complications, particularly diabetic retinopathy and macular edema.